We did not speak with people as part of this review.

We did not, on this occasion, speak to people who used the service, so cannot report what they said.

Patients and service users were not interviewed for this particular review, due to the nature of the ambulance operation. However, a review of patient views, undertaken in February 2010, showed that overall quality of service was viewed as excellent. In the majority of cases, vehicles were seen as being comfortable and suitable to needs, in all cases there was total confidence in the ambulance staff and in the majority of cases patients reported that pain was controlled.

This NHS 111 service is rated as good overall. (Previous inspection May 2016 – Good overall with requires improvement in the effective domain)

The key questions are now rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We inspected this NHS 111 service as part of our inspection programme. This was a planned comprehensive inspection which looked at breaches in regulations identified at the inspection in May 2016 and looked at what action the provider had taken in relation to concerns regarding staffing recruitment.

We carried out an inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The NHS 111 service provided a safe, caring, responsive and well-led service to a diverse population spread across central and south England.
• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• Governance systems and processes were embedded and established.
• The provider recognised where risks were identified and were proactive in mitigating and reducing these risks. For example, low staff recruitment and retention had triggered the successful implementation of a demand and recovery plan.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence- based guidelines.
• The provider worked with outside agencies and charities to secure improvements to services.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• Staff had been trained and were monitored to ensure they used NHS pathways safely and effectively. (NHS pathways is a licensed computer based operating system that provides a suite of clinical assessments for triaging telephone calls from patients based on the symptoms they report when they call).
• The provider continued to be used as an approved national testing site for new NHS pathways being introduced.
• The provider was responsive and acted on patient complaints and feedback. Feedback from patients was welcomed by the provider and used to improve the service.
• The service were also involved in many projects, joint working and displayed evidence of innovation. For example, being appointed to lead a project for urgent and emergency care and in the provision of new services.
• The provider was testing a new training programme to help training in the workplace. The equipment allowed non clinical staff to experience a range of medical conditions they would not otherwise see and assist in the telephone triage.
• There was visible leadership, with an emphasis on continuous improvement and development of the service. For example, expansion of the service and integration with other stakeholders and urgent care providers.
• The provider was creative and proactive in looking at ways to solve staffing issues. For example, the use of home workers, joint working and change in working patterns to attract more staff. Staffing gaps had been met to provide patient safety. This was maintained through use of external call centre providers and offering overtime shifts.
• Staff said the NHS 111 service was a good place to work, although acknowledged this had been stressful recently due to issues with staff recruitment.
• The provider cared about the wellbeing of the staff and had invested in wellbeing officers who provided pastoral and operational support for staff. This had contributed to a reduction in staff sickness levels.

The areas where the provider should make improvements are:

• Continue with the implementation and monitoring of the recruitment programme.
• Ensure systems are in place to enable staff to keep abreast of changes, updates and new policies.
• Continue to review call handling responses to ensure agreed targets are achieved.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice